DEPRESSION

Depression is perhaps the most common of all mental health problems,
currently felt to affect one in every four adults to some degree. Depression is
a problem with mood/feeling in which the mood is described as sad, feeling down
in the dumps, being blue, or feeling low. While the depressed mood is present,
evidence is also present which reflects the neurochemical or "brain chemistry"
aspects of depression with the depressed individual experiencing poor
concentration/attention, loss of energy, accelerated thought/worry,
sleep/appetite disturbance, and other physical manifestations. When this
diagnosis is present, the individual will exhibit at least five of the following
symptoms during the depressive periods:

- Recurrent thoughts of death or suicide, an expressed desire to be dead

Causes of Depression:

Depression can occur under many circumstances but most commonly is present in
these two situations:

Sudden Severe Loss In this situation, the individual has experienced a
sudden, perhaps surprising severe loss. This loss may be the death of a loved
one, loss of a job, loss of friendship, or other grief process. In this type of
depression, the patient can clearly identify what is creating the depressed
mood.

Long-term High Stress Level In this situation, the patient is
depressed but can't quite put their finger on the cause, the "I'm depressed but
I don't know why" condition. Imagine running a video tape of your life,
reviewing the past 18 months. Look at the stress you've been under, the amount
of responsibility, the number of pressures, and the number of hassles. In actual
clinical practice, this cause of depression is seen more often than sudden loss.
This type of depression creeps up on you. When this type of depression is
experienced, the patient offers comments such as: "I don't know what's wrong!"
"I don't know how I feel." "My feelings are numb."

Brain Chemistry and Depression:

The human brain operates, much like your automobile, on fluids called
neurotransmitters. Just as your automobile has brake fluid, antifreeze,
transmission fluid, and oil - your brain runs on these neurotransmitters. Some
give us energy, like those related to adrenalin, some control body movements
("dopamine" as an example), and some control mood.

The brain neurotransmitter often associated with depression is called
serotonin. Serotonin is the brain's "oil", a rather slow-acting
neurotransmitter that is associated with sleep, appetite, energy, alertness, and
mood - just to name a few. Using the automobile as an example, if we drive our
car to California at a speed of 120 mile per hour, running the engine hot for a
long time, it would obviously use more oil. As long as we provided gas, however,
it would continue to run. Now suppose in our trip that for every two quarts of
oil we burn, we only replace one quart. By the time we reached California we'd
be several quarts low and our engine would be obviously overworked and
overheated.

During long-term high stress, the brain burns its' oil, serotonin, at a
higher rate. The bottomline in depression and stress: The brain burns up
more serotonin than it can replace! In the end result, after many
months of severe stress, the brain is using serotonin faster than it can
create/replace it. Your neurochemical level of serotonin drops and you become
depressed.

You'll know your Serotonin level is low (and depression is here) by the
following symptoms:

2. Concentration and attention will drop. Depressed children/students will
experience a drop in grades. You'll start putting odd things in the refrigerator
(a bowling ball is the office record!), forget why you went to the grocery, and
become very forgetful and scatterbrained at work/home.

3. You'll lose physical energy. You can sleep for ten hours and you'll still
be bone tired. You will cry at the drop of a hat - driving down the highway,
doing dishes, sitting at work, etc.

4. Sexual interest, appetite, and general interest will rapidly drop. You
will stop answering the phone, stop visiting friends/relatives, and pull the
blinds.

5. Most dangerous - your mind speed will increase. Your mind will race at
what seems like 200 miles per hour. Depressed people often tell their doctor "I
can't get my mind to stop!" The minute you wake up in the morning - it will
start up. Your brain will then turn against you. It will reach in your memory
and pull out every bad memory it can find - abuse as a child, failed
relationships, etc. - anything to make you feel bad and especially guilty. You
will be tortured by your own thoughts.

6. As your mind speed picks up, the "garbage truck" will arrive. While the
brain is already torturing you with the past, it will create/invent new
ideas/thoughts to torture you. In every case of depression, if the depression
stays long enough, you will receive the same "garbage" thoughts from your mind.
You will be told:

- you are a burden to your family/friends

- you have failed/disappointed your family

- no one really cares about you

- your children would be better raised by someone else

- your family would be better off without you

- your spouse would be better off without you

- you are going crazy and there's no hope

- it would be better if you weren't around

- you would be better off dead

- you should probably kill yourself

If you're depressed - then you already know about the garbage truck. It's
almost impossible to explain this part, and the excessive mind speed, to someone
who has never been seriously depressed. If your depression goes untreated, this
constant "garbage" will totally destroy your self-confidence. Try as you may,
you will be unable to control this part of depression.

7. As part of the "garbage truck", your mind will try to make you as
uncomfortable as possible. You may be flooded with thoughts of violence (against
yourself and others), you'll think you are condemned by God, or you'll think you
deserve this condition for some reason. Your garbage will also tell you that if
you seek professional help (physician, psychologist, psychiatrist, etc.) that
you'll be committed to an institution forever.

8. When depressed, your brain begins running a mental "video tape" of your
worst hits/experiences. If married, a mental tape of the marriage is played
daily, only focusing on the worst experiences. If you are young, you will
suddenly become preoccupied with your upbringing, who got the best gym shoes,
the favorite child, the car you never received. Frequent if not constant
thoughts and preoccupations about past problems and issues is a common sign of
depression.

In short, depression is a neurochemical reaction to severe and prolonged
stress, either suddenly surfacing or gradually creeping up on you over a period
of many months. The treatment for this dark cloud is much easier than you think.

Current Treatment for Depression:

Treatment for depression frequently involves two programs, one using
antidepressant medication and the other repairing the damage done by months of
"garbage". In all current research, the best way to recover from a severe
depression is using both methods.

Medication Treatment: Remember the automobile example, being
several quarts low after running too hot for too long. Depression is treated
medically in a similar manner - we add a few quarts of oil until the fluid level
(Serotonin) is normal. In depression, we use antidepressant medication to "add"
the brain's oil, in most cases, Serotonin. An antidepressant medication slowly
increases the Serotonin in the brain. Prozac, Zoloft, and the newest "Paxil" are
antidepressants especially made for this purpose. They form a new class of
antidepressant medications, SSRI's, or (ready for this?) Selective Serotonin
Reuptake Inhibitors (SSRI).

As in the automobile, as your "oil" level goes up, your symptoms go down.
Most antidepressant medications require at least four to six weeks to increase
the serotonin level significantly although you'll notice improvements after the
first week. Antidepressant medications, the SSRI's for example, often stop
crying spells in five to seven days and stop the "garbage truck" in five to ten
days.

Psychological Treatment: Psychologists and other therapists
work with you to repair the damage done by the "garbage", helping you sort out
reality from what your brain has fed you over the past many months. Many people
feel going to a psychologist or therapist involves laying on a couch and talking
about your toilet training during childhood - Nonsense! Modern psychologists are
experts in not only brain chemistry, but how to repair "thinking" damage and
rebuild/reconstruct your confidence. The combination of medication and
therapy is extremely effective.

Usually, successful treatment for severe depression involves both medication
and therapy/counseling. With both, you can expect normal sleep to return first,
followed by a slowing of mind speed and the garbage truck leaving.

Some General Thoughts:

1. Depression is the most common mental health problem treated by modern
psychologists and psychiatrists. In most cases, hospitalization is not required
unless you have waited until you have active suicidal thoughts.

2. If you are depressed, expect your brain to be filled with mental garbage -
get ready for it! During this time, do not take action on those garbage thoughts
and make no major changes in your life. It's best to wait until the garbage
truck leaves before making decisions that will or may change our life.

3. Depression has been researched by physicians, psychologists,
psychiatrists, scientists, and others. Listen to the advice of your
professionals who study depression - not your neighbors or your aunt Gladys. If
placed on medication, you may be told "Don't take that Dope!". Remember, the
people giving you advice don't have a 200 mile-per-hour garbage truck following
them! Stick with professional opinion. Depression is a chemical problem, not
caused by demons, devils, poor eating habits, a new moon, or other old-wives
tales.

4. You may have other symptoms with your depression, such as severe anxiety
or agitation (pacing, no sleep at all, "hyper", etc.). That only means another
neurochemical has kicked in. In these cases, a psychiatrist can best select the
medication for the combination of anxiety and depression.

5. When you are depressed, those who love you will become a pain-in-the-butt.
They will "bug" you constantly, trying to cheer you up, giving you advice ("snap
out of it" is most common), and trying to be by your side. Children will become
shadows when their mother is depressed, almost protecting Mom. Be prepared for
this.

6. During depression, remember that your brain goes on a bad-memory hunt,
looking for old memories to torture you. Be prepared to relive or re-feel old
hurts, old doubts, old guilt, and old sorrows. Be curious about what memory
files the brain selects rather than focus on those memories. You can expect your
brain to constantly replay the video tape (your "worst hits" tape) of your life.
You'll feel guilty for things you did as a child, mistakes you made ten years
ago, etc. You'll live in the past as long as the depression remains. It may
interest you to know that as the serotonin level increases, the "past" returns
to the past as a memory - not a torture.

7. As your brain tortures you, it may "lock on" horrible thoughts. You may
feel you have a terminal disease. You may become preoccupied with guns, evil
thoughts, etc. Often, individuals feel they are somehow contaminated by a killer
disease, fearing they will pass it to their family. One husband brought his wife
in for treatment when she began fixing breakfast in a surgical mask and rubber
gloves! One man sought treatment at the office after nailing his closet door
shut with 148 nails - his brain became preoccupied with the shotgun in that
closet, telling him to kill his family and then himself.

In other depressed situations, people become obsessed with other issues,
almost always "the road not taken". Often viewed as mid-life crisis, a
straight-laced businessman now wants a Harley and a tattoo while another
individual begins suddenly thinking about a past sweetheart. In almost all of
these situations, the individual acts totally out of character.

8. All depressed folks look for escapes. Common methods of trying to escape
depression are excessive alcohol use, drugs, sexual relationships, changing
jobs, etc. A lot of good marriages are lost during these times as the spouse of
the depressed partner hears "I've got to have space" or "I've got to get away
and find myself!" You'll find these escapes don't work. These methods only
complicate your depression and your recovery. Best bet - don't make changes,
just get to a professional.

9. Most people classify all medications that act on emotions as "nerve
pills". This is far from the truth. Psychiatrists actually have medications for
anxiety/nervousness (Valium, Ativan, Xanax, etc.) and those for depression
(Elavil, Prozac, Zoloft, Sinequan, etc.). Different brain chemicals are involved
in each condition and many people make the serious mistake of taking an
antianxiety medication for their "nerves", thinking they are treating their
depression - Wrong! While you will be calmer, you will stay depressed. It's like
drinking six beers for a broken arm - you might feel the pain less but your arm
is still broken. A psychiatrist is most qualified to select the proper
medication for your condition.

10. If you are placed on medication, don't expect an immediate recovery. With
antidepressants, it's similar to refilling the oil in the car, only at 1/8th of
a quart a day. As you continue to take the medication, your mood will slowly
improve as the serotonin level increases in the brain. When depressed, every day
is bad and full of mental garbage. As medication continues, you'll have a bad,
then good day. As serotonin gets higher, you'll have a bad morning, then three
good days. In short, it's bad-and-good at first, then finally good days with
routine hassles. No one is happy all the time. People that are happy all the
time are institutionalized - it's not normal. "Normal" is a good mood with
normal reactions to the stress of everyday life.

11. In selecting a therapist/counselor, each one is different. All have
different personalities, styles, and attitudes. Select one that has your style
and most important - somebody that makes sense. If you meet one that says "I
don't believe in medications" - get out of there! That therapist is about thirty
years behind modern treatment. Often, your family physician is in a position to
recommend the best therapist in your area. You can also look for signs of
acceptance in the professional community, such as hospital privileges. You may
have to shop around to find a therapist right for you.

As a word of caution, many inexperienced therapists or those with limited
training may miss the fact that you are depressed. You may arrive at the
therapist office preoccupied about something in your childhood that actually
happened 20 years ago. You may also fool your family physician with multiple
physical complaints as when Serotonin is low, all body systems seem to go
haywire. A properly trained therapist will not only asked about your life and
upbringing, but about the physical aspects of your situation; your sleep, sexual
interest, concentration, and other indicators of low-serotonin depression or
stress. The inexperienced therapist might focus on the "garbage truck" thoughts
and miss the big picture, the presence of depression. If you are clinically
depressed, weekly discussions of your past as told by the garbage truck will
only prolong your depression and possibly intensify it. If in doubt, consult
your family physician to obtain a medical/physical view of the situation as most
physicians are usually trained to recognize the indications of low-serotonin
depression. If you think depression is part of the problem, ask your family
physician to refer you to a psychiatrist or psychologist in your area.

12. Depression affects more than the individual with the depression - it's a
family-and-friends problem as well. If your spouse is depressed, he or she may
be constantly talking about the history of the marriage and relationship.
Remember, the "garbage truck" is running in their brain, thinking of every bad
thing that has been done, said, or not done. The spouse that isn't depressed is
frequently "dumped on" with hundreds of accusations and thoughts that are long
after-the-fact and totally beyond correction at this point. The nondepressed
spouse may suddenly learn that their partner never did like their
hairstyle, their mother, their choice of automobile, or the price of the house.
The nondepressed spouse will hear many "thoughts" that were present at the time
of marital decisions, often years ago, but were never mentioned. The
nondepressed spouse may be awakened at night with accusations and complaints
that may last for hours. The nondepressed spouse will be made to feel
responsible for these unspoken wishes and will be helpless as the depressed
spouse lists mistakes and misunderstandings that have taken place during the
entire marriage/relationship. Even though they might have been discussed at the
time, the nondepressed spouse will receive much blame for past events.

If your son or daughter is depressed, they may suddenly withdraw from the
family or become hostile. Due to their youth, most of their life experience is
associated with the family, remembering that family experiences makes up 70
percent of their mental video tape. For this reason, the "garbage truck" will be
reviewing every mistake or issue in their upbringing. In such cases, the parents
are "dumped on" with what they did wrong, bad decisions they've made in raising
the son/daughter, or feelings that were never discussed related to their
brothers or sisters. With the low self-esteem created by the depression and
stress, the son/daughter may be intensely rejecting, as though feeling they must
reject the parents before the parents have a chance to reject them. The anger
and hostility is often so strong that parents miss the fact that their
son/daughter is depressed - they're too busy dealing with accusations or
hostility to see the depressed mood.

Older sons and daughters may start apologizing for their behavior in their
childhood, seeking forgiveness - despite the fact that they are now parents
themselves. Parents may be shocked to find that their depressed married
son/daughter is suddenly thinking of divorce in a circumstance that is "out of
the blue" and totally unexpected.

If a friend is depressed, they will suddenly have no interest in maintaining
your friendship. They'll stop calling, visiting, or writing. If your depressed
best friend suddenly gives you their most prized possession or asks you to be
included in their will to take care of their children - be on the alert! Such
behaviors are often part of a suicide plan in which the depressed friend wants
to "take care of business" before they leave this earth. At that point, a
heart-to-heart talk is needed, perhaps offering to accompany them to a
professional's office for help. Many depressed individuals are brought to the
office by their parents, friends, ministers, union stewards, or work
supervisors.

Conclusions:

Depression, at some level, will hit every adult eventually. While most
depressions are brief, with our serotonin gradually returning as stress
decreases, when depression comes and stays you may need professional treatment
to recover. If you think you may have depression, obtain an opinion from a
mental health or medical professional. That professional can then guide you in
the direction of additional treatment and/or possible medication. Depression is
no longer a mystery and is easily treated by modern methods. Treatment is
usually short-term, there's no lying on a couch, and your insurance covers most
of the charges in Ohio and other states. Your community mental health
professionals are your clinical psychologists, psychiatrists, social workers,
and those at your community health-care facilities.

Credit: This handout was written by Joseph M. Carver, Ph.D., a
psychologist in private practice at Joseph M. Carver, Ph.D., Inc. in Portsmouth,
Ohio. The handout is provided as a public service to the community.